Eligibility Questionnaire

Eligibility Questionnaire

The Energy Balance Laboratory and The Center for Physical Activity and Weight Management at the University of Kansas supports the practice of protection for human subjects participating in research. You should be aware that even if you agree to participate, you are free to withdraw at any time without penalty.

We are conducting this prescreening to better understand if you are eligible for the study. This will entail your completion of an online questionnaire. Your participation is expected to take approximately 1-3 minutes to complete. The content of the questionnaire should cause no more discomfort than you would experience in your everyday life.

Your participation is solicited, although strictly voluntary. Your name will not be associated in any way with the research findings. Your identifiable information will not be shared unless (a) it is required by law or university policy, or (b) you give written permission. Data will be maintained on a secure server located behind a HIPAA Complaint Firewall.

*It is possible, however, with internet communications, that through intent or accident someone other than the intended recipient may see your response.

Completion of the questionnaire indicates your willingness to take part in this study and that you are at least 18 years old. If you are eligible to participate we will contact you, schedule a time to read the study consent, and answer any questions you many have.

If you have any additional questions about your rights as a research participant, you may call (785) 864-7429 or write the Human Research Protection Program (HRPP), University of Kansas, 2385 Irving Hill Road, Lawrence, Kansas 66045-7563, email irb@ku.edu.

Sincerely,

Joseph E. Donnelly, EdD, FACSM Professor/Director, Energy Balance Laboratory & The Center for Physical Activity and Weight Management 1301 Sunnyside Ave. Robinson Center Rm 100 The University of Kansas Lawrence, KS 66045

Questions about procedures should be to directed to: Anna M. Gorczyca, PhD University of Kansas Medical Center 3901 Rainbow Blvd. Mailstop 1058, Attn: EBL Kansas City, KS 66160 785-813-6595 mdex@ku.edu

I agree to complete the eligibility questionnaire:   Yes   No


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